The 20th International Conference on AIDS and STIs in Africa (ICASA), to be held in Kigali in December, will provide an opportunity for Rwandans to share what they have learned about preventing HIV infections and increasing the life expectancy of people living with HIV, The New Times reports. The successful approaches described in the article include providing antiretroviral treatment to all HIV-positive individuals regardless of viral load, decentralizing HIV testing and treatment services to 510 public health facilities, dispatching mobile condom kiosks to “hot spots” of risky sexual activity, and providing voluntary medical male circumcision (VMMC) services. The proportion of men who were circumcised doubled from 13 percent in 2010 to 30 percent to 2015 (The New Times, 18 November 2019).
News & Events
When Malawian community mobiliser Ajasi Bamusi turns up at football matches, he is keen for halftime. “I negotiate with the team captain to use halftime to give a talk promoting voluntary male medical circumcisions (VMMC)," explains Bamusi in an article from the World Health Organization. The community mobiliser described his halftime talks during a session at the 20th International Conference on AIDS and STIs in Africa (ICASA 2019) in Kigali, Rwanda. The talks are part of a 15-country effort to encourage men and boys to opt for VMMC, which reduces the risk of acquiring HIV by about half. From 2008 to 2019, almost 23 million men and boys became circumcised in eastern and southern Africa, averting an estimated 250,000 HIV infections. VMMC is projected to prevent another 660,000 HIV infections in the next decade and can serve as an entry point to essential health services for men and boys (AllAfrica, 4 December 2019).
Speaking at a World AIDS Day event in Klerksdorp, South Africa’s Deputy President David Mabuza called on communities to end the stigma associated with HIV and discrimination against people living with the virus, News24 reports. Ending the epidemic and gender-based violence will require changes in social attitudes and norms, he said. Mabuza also recognized progress against HIV in South Africa, which has the world’s largest HIV treatment programme and has provided voluntary medical male circumcision services to almost 4 million men and boys (News24, 1 December 2019).
Almost 4.5 million men and boys have been circumcised in Tanzania since the voluntary medical male circumcision (VMMC) programme began in 2009, The Citizen reports. The article quotes a programme officer from Tanzania’s National AIDS Control Programme, who spoke at an HIV workshop in Dodoma about the VMMC programme’s progress. Since the introduction of early infant male circumcision in a pilot project in the Iringa region in 2013, 13,603 infants have been circumcised. The government aims to provide VMMC services to an addition 2.7 million men by 2022 (The Citizen, 15 November 2019).
In a small village in Kenya’s Laikipia County, the elders of the Samburu people have incorporated medical male circumcision into the traditional initiation ceremony for boys, The Standard reports. In the article, one of the elders explains that they decided to have a professional clinical officer from the community perform male circumcisions to improve the safety of the procedure. He is quoted as saying that in the past, traditional healers used one knife to circumcise all the initiates, exposing them to diseases, “and that is why we chose to use one of our own who is a professional.” This medical service is incorporated into the traditional ceremony rather than replacing it, according to the clinical officer (The Standard, 13 November 2019).
A study found that the introduction and expansion of combination HIV prevention services, including HIV testing, voluntary medical male circumcision (VMMC), and antiretroviral therapy, led to significant decreases in new HIV infections in four Ugandan fishing villages heavily affected by HIV, Healio reports. The authors of the study write in The Lancet HIV that “to our knowledge this is the first report of prospectively observed declines in overall HIV incidence with rapid scale-up of combination HIV interventions in HIV-hyperendemic communities.” HIV incidence dropped from 3.43 per 100 person-years in 2011 to 1.59 person-years in 2017 as the number of people benefiting from combination prevention increased. VMMC coverage increased from 35 to 65 percent, and circumcised men had a lower risk of incident HIV compared to uncircumcised men. Despite surpassing the 90-90-90 targets for HIV testing, treatment, and viral suppression, however, these villages still have an HIV incidence 15 times higher than the rate needed for epidemic control (Healio, 30 September 2019).
Zimbabwe recorded declines in new HIV infections of 9 percent among adults and 27 percent among children from 2015 to 2018, The Herald reports. A government official, speaking at the launch of a two-week review of the national HIV programme, attributed these gains and a 60 percent reduction in AIDS-related deaths from 2010 to 2017 to the collective efforts of the government and the private sector. Interventions the government has instituted include voluntary medical male circumcision, pre-exposure prophylaxis, condom promotion and provision, HIV testing, prevention of mother-to-child transmission of HIV, prevention and management of sexually transmitted infections, and provision of antiretroviral therapy. The review will identify gaps in these programmes and generate recommendations to help Zimbabwe achieve the goal of ending the epidemic by 2030 (The Herald [Zimbabwe], 17 September 2019).
To achieve the goal of providing 25 million voluntary medical male circumcisions (VMMCs) by 2020, programmes in southern and eastern Africa would need to reach an additional 15 million men and adolescent boys, according to the 2019 Global AIDS Update from the Joint United Nations Programme on HIV/AIDS (UNAIDS). Avert reports that the VMMC goal is one of the many global HIV targets unlikely to be met by 2020. Reductions in the annual number of new HIV infections appear to have stalled, and the resources available for the global response to HIV declined for the first time in 2018, from $19.6 billion in 2017 to $19 billion in 2018 (Avert, 9 August 2019).
A new mobile health clinic is allowing rapid expansion of voluntary medical male circumcision (VMMC) services in the hills of Tanzania’s Morogoro Region, reports the Daily News. The article feature Joseph Anthony, a 21-year-old brick maker who lives in a village outside the clinic. Previously unable to access male circumcision because of financial constraints, Joseph is now one of more than 800,000 Tanzanian men who have been circumcised at no cost since 2015. The clinic also offers free HIV counselling and testing, tuberculosis treatment, and family planning education (Daily News [Tanzania], 4 August 2019).
On the first World Patient Safety Day on 17 September 2019, the World Health Organization launched a global campaign to create awareness of patient safety and urge people to show their commitment to making healthcare safer. Campaign materials and information about improving patient safety are available here. For information on the safety of voluntary medical male circumcision (VMMC) services and resources to help programmes assure and improve the quality of VMMC services, see the Clearinghouse’s Quality assurance and Safety research pages.
A report released at the IAS 2019 conference in Mexico City documents dramatic reductions in HIV incidence and mortality achieved in six different settings, Africa Science News reports. Lower rates of new HIV infections and HIV-related deaths have been attributed to campaigns to encourage HIV testing, free access to treatment at the time of diagnosis with HIV, and scale-up of evidence-based HIV prevention, such as voluntary medical male circumcision, pre-exposure prophylaxis and harm reduction. Chris Collins, president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, is quoted as saying the report shows that “ending the epidemic isn’t an insurmountable challenge but a question of putting the evidence to work and scaling access, particularly for those most at risk” (Africa Science News, 23 July 2019).
The rate of new HIV infections dropped by about 30 percent in three studies of intensive HIV interventions, but they did not achieve the larger reductions in incidence that had been expected, The New York Times reports. The studies, conducted in five African countries among almost 1.5 million people, assessed the impact of testing everyone in a community for HIV and providing antiretroviral treatment (ART) to those who test positive. In all three studies, communities were randomly assigned to receive either their country’s standard of care or the “test-and-treat” approach combined with other services, such as testing and treatment for TB and sexually transmitted infections, counseling, condoms, prenatal care, and voluntary medical male circumcision. The standard of care in the countries changed during the studies to expand access to ART, making it difficult to measure the effect of combination HIV prevention (The New York Times, 17 July 2019).
Linking men to HIV services is a major challenge, reports South Africa’s Times Live, citing the latest Global AIDS Update from the Joint United Nations Programme on HIV/AIDS (UNAIDS). Times Live covered the release of the report in the Kwazulu-Natal town of Eshowe, where a project run by Doctors Without Borders has achieved the UNAIDS goals of 90-90-90 a year ahead of the 2020 deadline. In Eshowe, 90 percent of people living with HIV know their status, 94 percent of those who know they are HIV-positive are on antiretroviral treatment, and 95% of those on treatment have a suppressed viral load. But reaching men has proved difficult, despite initiatives such as a male clinic at a taxi rank and transport to and from weekend VMMC camps (Times Live, 13 July 2019).
Many parents in South Africa's Limpopo Province have lost faith in the traditional way of circumcising boys and are turning to voluntary medical male circumcision (VMMC), Health-e News reports. Several parents who had taken their sons for VMMC cited concerns about the safety, hygiene, and cost of the traditional rite of passage. A general practitioner from a health centre in the village of Mokgoloboto is quoted as saying that 150 boys have been circumcised at the facility (Health e-News, 27 June 2019).
Registration is open for a 22 May webinar on approaches to sustaining voluntary medical male circumcision (VMMC) services, including recommendations from the World Health Organization and examples of countries’ steps toward sustainability in VMMC leadership, systems, financing, and strategic information.